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The association between insight and symptoms in bipolar inpatients: An Italian prospective study

Published online by Cambridge University Press:  30 November 2011

C. Bressi*
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122Milan, Italy
M. Porcellana
Affiliation:
Department of Mental Health, AO Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162Milan, Italy
P.M. Marinaccio
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122Milan, Italy
E.P. Nocito
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122Milan, Italy
M. Ciabatti
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122Milan, Italy
L. Magri
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122Milan, Italy
A.C. Altamura
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122Milan, Italy
*
*Corresponding author. Tel.: +39 0255035986; fax: ++39 0250320310. E-mail address:cinzia.bressi@unimi.it (C. Bressi).
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Abstract

Objective

To evaluate potential differences in insight among bipolar manic, mixed and bipolar depressed inpatients and assess the role of clinical and demographic characteristics as possible predictors.

Method

One hundred and twenty consecutive inpatients divided into three diagnostic groups were studied on admission (T0), at discharge (T1) and at 18weeks after hospitalization (T2). The Young Mania Rating Scale (YMRS), the Hamilton Rating Scale for Depression (HAMD) and the Scale to Assess Unawareness of Mental Disorder (SUMD) were used.

Results

Patients with mixed mania showed highest scores on the SUMD than patients with mania or bipolar depression. It was found a significant relationship between improvements in mania and in the insight. The level of insight at baseline was the only predictor of awareness in social consequences, moreover clinical and demographic characteristics were predictors of insight into mental illness. For what concerns insight about therapy benefits it was influenced by level of mania at baseline.

Conclusion

The three general dimensions of insight revealed significant differences among the three groups. Regression models suggest that insight is a multidimensional concept in which some aspects are state-related, associated with psychopathology, whereas others are trait-like qualities, not directly associated with symptoms and predicted only by level at baseline.

Type
Original articles
Copyright
Copyright © European Psychiatric Association 2012

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References

Altamura, A.C., Bassetti, R., Sassella, F., Salvadori, D., Mundo, E.Duration of untreated psychosis as a predictor of outcome in first-episode schizophrenia: a retrospective study. Schizophr Res. 2001; 52: 2936.CrossRefGoogle ScholarPubMed
Altamura, A.C., Bassetti, R., Bigotti, S., Pioli, R., Mundo, E.Clinical variables related to suicide attempts in schizophrenic patients: a retrospective study. Schizophr Res. 2003; 60: 4755.CrossRefGoogle ScholarPubMed
Altamura, A.C., Dell’Osso, B., Vismara, S., Mundo, E.May duration of untreated illness influence the long-term course of major depressive disorder?. Eur Psychiatr. 2008; 23: 9296.CrossRefGoogle ScholarPubMed
Altamura, A.C., Buoli, M., Albano, A., Dell’Osso, B.Age at onset and latency to treatment (duration of untreated illness) in patients with mood and anxiety disorders: a naturalistic study. Int Clin Psychopharmacol. 2010; 25: 172179.CrossRefGoogle ScholarPubMed
Altamura, A.C., Dell’Osso, B., Berlin, H.A., Buoli, M., Bassetti, R., Mundo, E.Duration of untreated illness and suicide in bipolar disorder: a naturalistic study. Eur Arch Psychiatry Clin Neurosci. 2010; 260: 385391.CrossRefGoogle ScholarPubMed
Altamura, A.C., Porcellana, M., Marinaccio, P.M., Ciabatti, M., Nocito, E.P., Magri, L.et al.Is it possible to assess subjective well-being among bipolar inpatients? An 18-week follow-up study. Gen Hosp Psychiatry. 2011; 33: 185190.CrossRefGoogle ScholarPubMed
Amador, X.F., Strauss, D.H., Yale, S., Gorman, J.M., Endicott, J.The assessment of insight in psychosis. Am J Psychiatry. 1993; 150: 873879.Google ScholarPubMed
Amador, X.F., Flaum, M., Andreasen, N.C., Strauss, D.H., Yale, S.A., Clark, S.C.et al.Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry. 1994; 51: 826836.CrossRefGoogle ScholarPubMed
Amador, X.F., Friedman, J.H., Kasapis, C., Yale, S.A., Flaum, M., Gorman, J.M.Suicidal behavior in schizophrenia and its relationship to awareness of illness. Am J Psychiatry. 1996; 153: 11851188.Google ScholarPubMed
Amador, X.F., David, A.S.Insight and psychosis. 2nd edNew York: Oxford University Press; 2004.CrossRefGoogle Scholar
Angst, J., Sellaro, R.Historical perspectives and natural history of bipolar disorder. Biol Psychiatry. 2000; 48: 445457.CrossRefGoogle ScholarPubMed
Bauer, M., Unutzer, J., Pincus, H.A., Lawson, W.B.Bipolar disorder. Ment Health Serv Res. 2002; 4: 225229.CrossRefGoogle ScholarPubMed
Buckley, P.F., Hrouda, D.R., Friedman, L., Noffsinger, S.G., Resnick, P.J., Camlin-Shingler, K.Insight and its relationship to violent behavior in patients with schizophrenia. Am J Psychiatry. 2004; 161: 17121714.CrossRefGoogle ScholarPubMed
Cassidy, F.Insight in bipolar disorder: relationship to episode subtypes and symptom dimensions. Neuropsychiatr Dis Treat. 2010; 6: 627631.CrossRefGoogle ScholarPubMed
Cuffel, B.J., Alford, J., Fisher, E.P., Owen, R.R.Awareness of illness in schizophrenia and outpatient treatment adherence. J Nerv Ment Dis. 1996; 184: 653659.CrossRefGoogle ScholarPubMed
De Hert, M.A.F., Simon, V., Vidovic, D., Franic, T., Wampers, M., Peuskens, J.et al.Evaluation of the association between insight and symptoms in a large sample of patients with schizophrenia. Eur Psychiatry. 2009; 24: 507512.CrossRefGoogle Scholar
Dell’Osso, L., Pini, S., Cassano, G.B., Mastrocinque, C., Seckinger, R.A., Saettoni, M.et al.Insight into illness in patients with mania, mixed mania, bipolar depression and major depression with psychotic features. Bipolar Disord. 2002; 4: 315322.CrossRefGoogle ScholarPubMed
Dias, V.V., Brissos, S., Carita, A.I.Clinical and neurocognitive correlates of insight in patients with bipolar I disorder in remission. Acta Psychiatr Scand. 2008; 117: 2834.Google ScholarPubMed
Dias, V.V., Brissos, S., Frey, B.N., Kapczinski, F.Insight, quality of life and cognitive functioning in euthymic patients with bipolar disorder. J Affect Dis. 2008; 110: 7583.CrossRefGoogle ScholarPubMed
First, M.B., Gibbon, M., Spitzer, R.L., Williams, J.B.User Guide for the Structural Clinical Interview for DSM-IV (SCID) Axis I Disorders. Washington, DC: American Psychiatry Association; 1996.Google Scholar
Ghaemi, S.N., Boiman, E., Goodwin, F.K.Insight and outcome in bipolar, unipolar and anxiety disorders. Compr Psychiatry. 2000; 41: 167171.CrossRefGoogle ScholarPubMed
Ghaemi, S.N., Rosenquist, K.J.Is insight in mania state-dependent? A meta-analysis. J Nerv Ment Dis. 2004; 192: 771775.CrossRefGoogle ScholarPubMed
Gharabawi, G.M., Lasser, R.A., Bossie, C.A., Zhu, Y., Amador, X.Insight and its relationship to clinical outcomes in patients with schizophrenia or schizoaffective disorder receiving long-acting risperidone. Int Clin Psychopharmacol. 2006; 21: 233240.CrossRefGoogle ScholarPubMed
Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23: 5662.CrossRefGoogle ScholarPubMed
Kaiser, S.L., Snyder, J.A., Corcoram, R., Drake, R.J.The relationship among insight, social support and depression in psychosis. J Nerv Ment Dis. 2006; 194: 905908.CrossRefGoogle ScholarPubMed
Kemp, R.A., Lambert, T.J.Insight in schizophrenia and its relationship to psychopathology. Schizophr Res. 1995; 18: 2128.CrossRefGoogle ScholarPubMed
Kessing, L.V., Sondergard, L., Kvist, K., Andersen, P.K.Suicide risk in patient treated with lithium. Arch Gen Psychiatry. 2005; 62: 860866.CrossRefGoogle ScholarPubMed
MacQueen, G.M., Young, L.T., Joffe, R.T.A review of psychosocial outcome in patients with bipolar disorder. Acta Psychiatr Scand. 2001; 103: 163170.CrossRefGoogle ScholarPubMed
Mintz, A.R., Dobson, K.S., Rommey, D.M.Insight in schizophrenia: a meta-analysis. Schizophr Res. 2003; 61: 7588.CrossRefGoogle ScholarPubMed
Moore, O., Cassidy, E., Carr, A., O’Callaghan, E.Unawareness of illness and its relationship with depression and self-deception in schizophrenia. Eur Psychiatry. 1999; 14: 264269.CrossRefGoogle Scholar
Osatuke, K., Ciesla, J., Kaskow, J.W., Zisook, S., Mohamed, S.Insight in schizophrenia: a review of etiological models and supporting research. Compr Psychiatry. 2008; 49: 7077.CrossRefGoogle ScholarPubMed
Pallanti, S., Quercioli, L., Pazzagli, A., Rossi, A., Dell’Osso, L., Pini, S.et al.Awareness of illness and subjective experience of cognitive complaints in patients with bipolar I and bipolar II disorder. Am J Psychiatry. 1999; 156: 10941096.Google ScholarPubMed
Peralta, V., Cuesta, M.J.Lack of insight in mood disorder. J Affect Dis. 1998; 49: 5558.CrossRefGoogle Scholar
Pini, S., de Queiroz, V., Dell’Osso, L., Abelli, M., Mastrocinque, C., Saettoni, M.et al.Cross-sectional similarities and differences between schizophrenia, schizoaffective disorder and mania or mixed mania with mood-incongruent psychotic features. Eur Psychiatry. 2004; 19: 814.CrossRefGoogle ScholarPubMed
Pyne, J.M., Bean, D., Sullivan, G.Characteristics of patients who do not believe they are mentally ill. J Nerv Ment Dis. 2001; 189: 146153.CrossRefGoogle Scholar
Rossi, A., Daneluzzo, E., Arduini, L., Di Domenico, M., Stratta, P., Petruzzi, C.Cognitive symptoms of mania in pure and mixed episodes evaluated with the positive and negative syndrome scale. Eur Arch Psychiatry Clin Neurosci. 2000; 250: 254256.CrossRefGoogle ScholarPubMed
Schwartz, R.C., Smith, S.D.Suicidality and psychosis: the predictive potential of symptomatology and insight into illness. J Psychiatr Res. 2004; 38: 185191.CrossRefGoogle ScholarPubMed
Scott, J.Psychotherapy for bipolar disorder. Br J Psychiatry. 1995; 167: 581588.CrossRefGoogle ScholarPubMed
Sevy, S., Nathanson, K., Visweswaraiah, H., Amador, X.The relationship between insight and symptoms in schizophrenia. Compr Psychiatry. 2004; 45: 1619.CrossRefGoogle Scholar
Shad, M.U., Muddasani, S., Keshevan, M.S.Prefrontal subregions and dimensions of insight in first-episode schizophrenia: a pilot study. Psychiatry Res. 2006; 146: 3542.CrossRefGoogle ScholarPubMed
Smith, T.E., Hull, J.W., Goodman, M., Hedayat-Harris, A., Willson, D.F., Israel, L.M.et al.The relative influence of symptoms, insight, and neurocognition on social adjustment in schizophrenia and schizoaffective disorder. J Nerv Ment Dis. 1999; 187: 102108.CrossRefGoogle Scholar
Spearing, M.K., Post, R.M., Leverich, G.S., Brandt, D., Nolein, W.Modification of the Clinical Global Impressions (CGI) scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Res. 1997; 73: 159171.CrossRefGoogle ScholarPubMed
van der Werf-Eldering, M.J., van der Meer, L., Burger, H., Holthausen, E.A.E., Nolen, W.A., Aleman, A.Insight in bipolar disorder: associations with cognitive and emotional processing and illness characteristics. Bipolar Disord. 2011; 13: 343354.CrossRefGoogle ScholarPubMed
Varga, M., Magnusson, A., Flekkoy, K., Ronneberg, U., Opjordsmoen, S.Insight, symptoms and neurocognition in bipolar I patients. J Affect Disord. 2006; 91: 19.CrossRefGoogle ScholarPubMed
Varga, M., Magnusson, A., Flekkoy, K., David, A.S., Opjordsmoen, S.Clinical and nueropsychological correlates of insight in schizophrenia and bipolar I disorder: does diagnosis matter?. Compr Psychiatry. 2007; 48: 583591.CrossRefGoogle ScholarPubMed
Weiler, M.A., Fleisher, M.H., McArthur-Campbell, D.Insight and symptom change in schizophrenia and other disorders. Schizophr Res. 2000; 45: 2936.CrossRefGoogle ScholarPubMed
Wiffen, B.D.R., Rabinowitz, J., Lex, A., David, A.S.Correlates, change and ‘state or trait’ properties of insight in schizophrenia. Schizophr Res. 2010; 122: 94103.CrossRefGoogle ScholarPubMed
Yen, C.F., Chen, C.S., Yeh, M.L., Ker, J.H., Yang, S.J., Yen, J.Y.Correlates of insight among patients with bipolar I disorder in remission. J Affect Disord. 2004; 78: 5760.CrossRefGoogle ScholarPubMed
Yen, C.F., Chen, C.S., Ko, C.H., Yeh, M.L., Yang, S.J., Yen, J.Y.et al.Relationship between insight and medication adherence in outpatients with schizophrenia and bipolar disorder: prospective study. Psychiatry Clin Neurosci. 2005; 59: 403409.CrossRefGoogle Scholar
Yen, C.F., Chen, C.S., Ko, C.H., Yen, J.Y., Huang, C.F.Changes in insight among patients with bipolar I disorder: a 2-year prospective study. Bipolar Disord. 2007; 9: 238242.CrossRefGoogle ScholarPubMed
Yen, C.F., Chen, C.S., Yen, J.Y., Ko, C.H.The predictive effect of insight on adverse clinical outcomes in bipolar I disorder: a 2-year prospective study. J Affect Disord. 2008; 108: 121127.CrossRefGoogle Scholar
Yen, C.F., Cheng, C.P., Huang, C.F., Ko, C.H., Yen, J.Y., Chang, Y.P.et al.Relationship between psychosocial adjustment and executive function in patients with bipolar disorder and schizophrenia in remission: the mediating and moderating effects of insight. Bipolar Disord. 2009; 11: 190197.CrossRefGoogle ScholarPubMed
Young, R., Biggs, J., Meyer, D.A.A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978; 133: 429435.CrossRefGoogle ScholarPubMed
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